Video-driven simulation of lower limb mechanical loading during aquatic exercises

Understanding the mechanical demands of an exercise on the musculoskeletal system is crucial to prescribe effective training or therapeutic interventions. Yet, that knowledge is currently limited in water, mostly because of the difficulty in evaluating external resistance. Here I reconcile recent advances in 3D markerless pose and mesh estimation, biomechanical simulations, and hydrodynamic modeling, to predict lower limb mechanical loading during aquatic exercises. Simulations are driven exclusively from a single video. Fluid forces were estimated within 12.5±4.1% of the peak forces determined through computational fluid dynamics analyses, at a speed three orders of magnitude greater. In silico hip and knee resultant joint forces agreed reasonably well with in vivo instrumented implant recordings (R²=0.74) downloaded from the OrthoLoad database, both in magnitude (RMSE =251±125 N) and direction (cosine similarity = 0.92±0.09). Hip flexors, glutes, adductors, and hamstrings were the main contributors to hip joint compressive forces (40.4±12.7%, 25.6±9.7%, 14.2±4.8%, 13.0±8.2%, respectively), while knee compressive forces were mostly produced by the gastrocnemius (39.1±15.9%) and vasti (29.4±13.7%). Unlike dry-land locomotion, non-hip- and non-knee-spanning muscles provided little to no offloading effect via dynamic coupling. This noninvasive method has the potential to standardize the reporting of exercise intensity, inform the design of rehabilitation protocols and improve their reproducibility.

Backstroke-to-Breaststroke Turns Muscular Activity. A Study Conducted in Age Group Swimmers

The aims of this study were to compare surface electromyographic (EMG) activity and kinematic variables among open, somersault, bucket and crossover backstroke-to-breaststroke turning techniques, and identify relationships between the integrated electromyography (iEMG) and kinematics profile focusing on the rotation and push-off efficacy. Following a four-week of systematically increasing contextual interference intervention program, eight 12.38 ± 0.55 years old male swimmers randomly performed twelve repetitions (three in each technique) turns in and out of the wall at maximum speed until the 7.5 m reference mark. Surface EMG values of the right vastus lateralis, biceps femoris, tibialis anterior, gastrocnemius medialis, rectus abdominis, external oblique, erector spinae and latissimus dorsi were recorded and processed using the integrated electromyography (iEMG) and the total integrated electromyography (TiEMG) that was expressed as a percentage of iEMGmax to normalize per unit of time for each rotation and push-off phase. Complementarily, 2D sagittal views from an underwater video camera were digitized to determine rotation and push-off efficacy. The crossover turn presented the highest rotation and push-off iEMG values. Erector spinae and gastrocnemius medialis had the highest activity in the rotation and push-off phases (89 ± 10 and 98 ± 69%, respectively). TiEMG depicted a very high activity of lower limb muscles during push-off activity (222 ± 17 to 247 ± 16%). However, there were no relation between TiEMG and rotation and push-off time, tuck index and final push-off velocity during the rotation and the push-off phases across all the studied turning techniques. The rotation efficacy in age-group swimmers were dependent on rotation time (p = 0.04). The different turning techniques were not distinguishable regarding iEMG activity as a possible determinant of rotation and push-off efficacy. Our study has direct implications for selecting appropriate exercises and designing training programs for optimizing the rotation and push-off phases of backstroke-to-breaststroke turning at young ages.

Multi-animal pose estimation, identification and tracking with DeepLabCut

Estimating the pose of multiple animals is a challenging computer vision problem: frequent interactions cause occlusions and complicate the association of detected keypoints to the correct individuals, as well as having highly similar looking animals that interact more closely than in typical multi-human scenarios. To take up this challenge, we build on DeepLabCut, an open-source pose estimation toolbox, and provide high-performance animal assembly and tracking-features required for multi-animal scenarios. Furthermore, we integrate the ability to predict an animal's identity to assist tracking (in case of occlusions). We illustrate the power of this framework with four datasets varying in complexity, which we release to serve as a benchmark for future algorithm development.

Shoulder joint kinetics and dynamics during underwater forward arm elevation

Aquatic exercises are widely implemented into rehabilitation programs. However, both evaluating their mechanical demands on the musculoskeletal system and designing protocols to provide progressive loading are difficult tasks. This study reports for the first time shoulder joint kinetics and dynamics during underwater forward arm elevation performed at speeds ranging from 22.5 to 90°/s. Net joint moments projected onto anatomical axes of rotation, joint power, and joint work were calculated in 18 participants through a novel approach coupling numerical fluid flow simulations and inverse dynamics. Joint dynamics was revealed from the 3D angle between the joint moment and angular velocity vectors, identifying three main functions-propulsion, stabilization, and resistance. Speeds <30°/s necessitated little to no power at all, whereas peaks about 0.20 W⋅kg^-1 were seen at 90°/s. As speed increased, peak moments were up to 61 × higher at 90 than at 22.5°/s, (1.82 ± 0.12%BW⋅AL vs 0.03 ± 0.01%BW⋅AL, P < 0.038). This was done at the expense of a substantial decrease in the joint moment contribution to joint stability though, which goes against the intuition that greater stabilization is required to protect the shoulder from increasing loads. Slow arm elevations (<30°/s) are advantageous for joint mobility gain at low mechanical solicitation, whereas the intensity at 90°/s is high enough to stimulate muscular endurance improvements. Simple predictive equations of shoulder mechanical loading are provided. They allow for easy design of progressive protocols, either for the postoperative shoulder or the conditioning of athlete targeting very specific intensity regions.

Comparison of Visual Function and Ocular Hemodynamics between Pre- and Post-Menopausal Women

Purpose

The incidence of eye disease increases with age and can often be linked to worsening cardiovascular function and increasing intraocular pressure. Estrogen is known to have vasodilatory effects in the systemic circulation. Decreased estrogen levels during menopause may therefore complicate or contribute to ocular pathologies as estrogen receptors are found in both retinal and choroidal tissue. The purpose of this investigation was to determine the effects of menopause on visual function and cardiovascular and ocular hemodynamics.

Methods

Twelve premenopausal and 24 postmenopausal women were evaluated at the Indiana University School of Medicine during a single study visit. Vision screening and ocular blood flow evaluations were performed, including blood pressure, heart rate, visual acuity, contrast sensitivity, intraocular pressure, and retinal capillary and retrobulbar blood flow imaging. Vision and ocular hemodynamics were compared using unpaired Student t-tests with pp<0.05 regarded as statistically significant.

Results

The premenopausal group had significantly lower heart rate (-16.1 b/m, p=0.0001) and systolic blood pressure (-17.7 mmHg, p=0.003) than postmenopausal subjects. Contrast sensitivity was significantly higher (measured in log units) in premenopausal women in both the right (0.25, p=0.039; 0.16, p=0.039) and left (0.45, p=0.001; 0.27, p=0.032) eyes at 9 and 18 cycles per degree, respectively. Premenopausal women also had significantly lower intraocular pressure in both the right (-2.19 mmHg, p=0.024) and left (-1.74 mmHg, p=0.035) eyes. Total ocular perfusion was not significantly different between groups.

Conclusions

This pilot work suggests that postmenopausal women have lower contrast sensitivity detection and elevated intraocular pressures compared to premenopausal women. Premenopausal women have lower cardiovascular risk factors, while total ocular circulation was similar to post-menopausal women.

Explosive lower limb extension mechanics: An on-land vs. in-water exploratory comparison

During a horizontal underwater push-off, performance is strongly limited by the presence of water, inducing resistances due to its dense and viscous nature. At the same time, aquatic environments offer a support to the swimmer with the hydrostatic buoyancy counteracting the effects of gravity. Squat jump is a vertical terrestrial push-off with a maximal lower limb extension limited by the gravity force, which attracts the body to the ground. Following this observation, we characterized the effects of environment (water vs. air) on the mechanical characteristics of the leg push-off. Underwater horizontal wall push-off and vertical on-land squat jumps of two local swimmers were evaluated with force plates, synchronized with a lateral camera. To better understand the resistances of the aquatic movement, a quasi-steady Computational Fluid Dynamics (CFD) analysis was performed. The force-, velocity- and power-time curves presented similarities in both environments corresponding to a proximo-distal joints organization. In water, swimmers developed a three-step explosive rise of force, which the first one mainly related to the initiation of body movement. Drag increase, which was observed from the beginning to the end of the push-off, related to the continuous increase of body velocity with high values of drag coefficient (C_D) and frontal areas before take-off. Specifically, with velocity, frontal area was the main drag component to explain inter-individual differences, suggesting that the streamlined position of the lower limbs is decisive to perform an efficient push-off. This study motivates future CFD simulations under more ecological, unsteady conditions.

Modulation of upper limb joint work and power during sculling while ballasted with varying loads

The human musculoskeletal system must modulate work and power output in response to substantial alterations in mechanical demands associated with different tasks. In particular, in water, upper limb muscles must perform net positive work to replace the energy lost against the dissipative fluid load. Where in the upper limb are work and power developed? Is mechanical output modulated similarly at all joints, or are certain muscle groups favored? This study examined, for the first time, how work and power per stroke are distributed at the upper limb joints in seven male participants sculling while ballasted with 4, 6, 8, 10 and 12 kg. Upper limb kinematics was captured and used to animate body virtual geometry. Net wrist, elbow and shoulder joint work and power were subsequently computed through a novel approach integrating unsteady numerical fluid flow simulations and inverse dynamics modeling. Across a threefold increase in load, total work and power significantly increased from 0.38±0.09 to 0.67±0.13 J kg^-1, and 0.47±0.06 to 1.14±0.16 W kg^-1, respectively. Shoulder and elbow equally supplied >97% of the upper limb total work and power, coherent with the proximo-distal gradient of work performance in the limbs of terrestrial animals. Individual joint relative contributions remained constant, as observed on land during tasks necessitating no net work. The apportionment of higher work and power simultaneously at all joints in water suggests a general motor strategy of power modulation consistent across physical environments, limbs and tasks, regardless of whether or not they demand positive net work.

Upper limb joint forces and moments during underwater cyclical movements

Sound inverse dynamics modeling is lacking in aquatic locomotion research because of the difficulty in measuring hydrodynamic forces in dynamic conditions. Here we report the successful implementation and validation of an innovative methodology crossing new computational fluid dynamics and inverse dynamics techniques to quantify upper limb joint forces and moments while moving in water. Upper limb kinematics of seven male swimmers sculling while ballasted with 4kg was recorded through underwater motion capture. Together with body scans, segment inertial properties, and hydrodynamic resistances computed from a unique dynamic mesh algorithm capable to handle large body deformations, these data were fed into an inverse dynamics model to solve for joint kinetics. Simulation validity was assessed by comparing the impulse produced by the arms, calculated by integrating vertical forces over a stroke period, to the net theoretical impulse of buoyancy and ballast forces. A resulting gap of 1.2±3.5% provided confidence in the results. Upper limb joint load was within 5% of swimmer׳s body weight, which tends to supports the use of low-load aquatic exercises to reduce joint stress. We expect this significant methodological improvement to pave the way towards deeper insights into the mechanics of aquatic movement and the establishment of practice guidelines in rehabilitation, fitness or swimming performance.

Breaststroke swimmers moderate internal work increases toward the highest stroke frequencies

A model to predict the mechanical internal work of breaststroke swimming was designed. It allowed us to explore the frequency-internal work relationship in aquatic locomotion. Its accuracy was checked against internal work values calculated from kinematic sequences of eight participants swimming at three different self-chosen paces. Model predictions closely matched experimental data (0.58 ± 0.07 vs 0.59 ± 0.05 J kg(-1)m(-1); t(23)=-0.30, P=0.77), which was reflected in a slope of the major axis regression between measured and predicted total internal work whose 95% confidence intervals included the value of 1 (β=0.84, [0.61, 1.07], N=24). The model shed light on swimmers ability to moderate the increase in internal work at high stroke frequencies. This strategy of energy minimization has never been observed before in humans, but is present in quadrupedal and octopedal animal locomotion. This was achieved through a reduced angular excursion of the heaviest segments (7.2 ± 2.9° and 3.6 ± 1.5° for the thighs and trunk, respectively, P<0.05) in favor of the lightest ones (8.8 ± 2.3° and 7.4 ± 1.0° for the shanks and forearms, respectively, P<0.05). A deeper understanding of the energy flow between the body segments and the environment is required to ascertain the possible dependency between internal and external work. This will prove essential to better understand swimming mechanical cost determinants and power generation in aquatic movements.

Mesoaxial polydactyly is a major feature in Bardet-Biedl syndrome patients with LZTFL1 (BBS17) mutations

Ciliopathies are heterogeneous disorders sharing different clinical signs due to a defect at the level of the primary cilia/centrosome complex. Postaxial polydactyly is frequently reported in ciliopathies, especially in Bardet-Biedl syndrome (BBS). Clinical features and genetic results observed in a pair of dizygotic twins with BBS are reported. The following manifestations were present: retinitis pigmentosa, bilateral insertional polydactyly, cognitive impairment and renal dysfunction. X-rays of the hands confirmed the presence of a 4th mesoaxial extra-digit with Y-shaped metacarpal bones. The sequencing of LZTFL1 identified a missense mutation (NM_020347.2: p.Leu87Pro; c.260T>C) and a nonsense mutation (p.Glu260*; c.778G>T), establishing a compound heterozygous status for the twins. A major decrease of LZTFL1 transcript and protein was observed in the patient's fibroblasts. This is the second report of LZTFL1 mutations in BBS patients confirming LZTFL1 as a BBS gene. Interestingly, the only two families reported in literature thus far with LZTFL1 mutations have in common mesoaxial polydactyly, a very uncommon feature for BBS. This special subtype of polydactyly in BBS patients is easily identified on clinical examination and prompts for priority sequencing of LZTFL1 (BBS17).

Mutations in SDCCAG8/NPHP10 Cause Bardet-Biedl Syndrome and Are Associated with Penetrant Renal Disease and Absent Polydactyly

The ciliopathies are an expanding group of disorders caused by mutations in genes implicated in the biogenesis and function of primary cilia. Bardet-Biedl syndrome (BBS) is a model ciliopathy characterized by progressive retinal degeneration, obesity, polydactyly, cognitive impairment, kidney anomalies and hypogonadism. Mutations in SDCCAG8(NPHP10) were described recently in patients with nephronophthisis and retinal degeneration (Senior-Loken syndrome; SLS). Given the phenotypic and genetic overlap between known ciliopathy genes, we hypothesized that mutations in SDCCAG8 might also contribute alleles to more severe, multisystemic ciliopathies. We performed genetic and phenotypic analyses of 2 independent BBS cohorts. Subsequent to mutation screening, we made a detailed phenotypic analysis of 5 families mutated for SDCCAG8 (3 homozygous and 2 compound heterozygous mutations) and conducted statistical analyses across both cohorts to examine possible phenotype-genotype correlations with mutations at this locus. All patients with mutations in SDCCAG8 fulfilled the diagnostic criteria for BBS (retinal degeneration, obesity, cognitive defects, renal failure, hypogonadism). Interestingly, none of the patients with primary SDCCAG8 mutations had polydactyly, a frequent but not obligatory BBS feature. In contrast, the same patients displayed early-onset renal failure, obesity, as well as recurrent pulmonary and ENT infections. Comparison of the phenotypes of these families with our entire BBS cohort indicated that renal impairment and absent polydactyly correlated significantly with causal SDCCAG8 mutations. Thus, SDCCAG8 mutations are sufficient to cause BBS in 1-2% of our combined cohorts, and define this gene as the sixteenth BBS locus (BBS16). The absence of polydactyly and the concomitant, apparently fully penetrant association with early kidney failure represents the first significant genotype-phenotype correlation in BBS that potentially represents an indicator for phenotype-driven priority screening and informs specific patient management.

Measuring quality: from the system to the provider

The literature on quality has often focused on process indicators. In this paper we outline a framework for describing and measuring the quality of health systems in terms of a set of desirable outcomes. We illustrate how it can be measured using data collected from a recent evaluation of health system performance conducted by the World Health Organization (WHO). We then explore the extent to which this framework can be used to measure quality for all components of the system; for example, regions, districts, hospitals, and providers. There are advantages and disadvantages to defining quality in terms of outcomes rather than process indicators. The advantage is that it focuses the attention of policy makers on whether systems are achieving the desired goals. In fact, without the ability to measure outcomes it is not possible to be sure that process changes actually improve attainment of socially desired goals. The disadvantage is that measuring outcomes at all levels of the system poses some problems particularly related to the sample sizes necessary to measure outcomes. WHO is exploring this, initially in relation to hospitals. The paper discusses two major challenges. The first is the question of attribution, deciding what part of the outcome is due to the component of the system under discussion. The second is the question of timing, including all the effects of current health actions now and in the future.

Kinetics of productive and latent HIV infection in lymphatic tissue and peripheral blood during triple-drug combination therapy with or without additional interleukin-2

OBJECTIVE

To study decay rates of productively and latently infected cells in peripheral blood and lymph nodes during triple antiretroviral therapy and the possible impact of interleukin-2 (IL-2) on viral kinetics.

METHODS

In this non-randomized study, nine antiretroviral-naive HIV-positive patients received either saquinavir hard gel capsules 2400 mg three times daily (group I; four patients) or saquinavir soft gel capsules 1200 mg three times daily and IL-2 (group II), in both cases together with two nucleoside analogues. Plasma viraemia and lymphocyte subsets were analysed. Axillary lymph nodes were excised before and after 12 weeks of therapy. Lymph node sections were examined by in situ hybridization for HIV RNA, and productively infected cells were counted. Infection rates of FACS-sorted CD3, CD4 lymph node and peripheral blood mononuclear cells were determined by nested DNA PCR.

RESULTS

Baseline plasma HIV RNA levels ranged from < 25 to > 1 x 10(6) copies/ml and remained undetectable throughout the study in one patient in group I. Plasma viraemia became undetectable after 3 months in four patients (three in group I). Productively infected cells were markedly reduced in the follow-up lymph node specimens. HIV DNA-positive CD4 T cells were reduced in lymphoid tissue and peripheral blood in all six evaluable patients. There were no significant differences between the groups in the clearance rates of plasma virus and of HIV DNA-positive cells.

CONCLUSIONS

Combined antiretroviral therapy rapidly suppressed active HIV replication in plasma and lymphoid tissue. Latently infected cells were cleared at a slower rate. Viral clearance did not appear to be markedly affected by additional IL-2 therapy.

Arteriography of the left internal mammary artery graft utilizing a balloon-tipped floatation catheter: an alternative approach

In this report, we describe an alternative method to the conventional arteriographic techniques of the left internal mammary artery (LIMA) graft using a balloon-tipped floatation catheter placed within the left subclavian artery. The floatation catheter will serve as both an occluder of the subclavian artery as well as a port for contrast injection. It may be effectively employed in the rare instances where direct cannulation of the LIMA graft is not possible.

[Effect of salmeterol in obstructive sleep apnea syndrome]

The effect of inhaled long-acting beta 2-agonists on obstructive sleep apnoea syndrome (OSAS) is unknown, though from the pharmacological point of view both therapeutic and adverse effects might be discussed. The purpose of this study was to obtain data on the efficacy and safety of Salmeterol in patients with OSAS. In a randomised, double-blind, placebo-controlled, crossover study effects of Salmeterol were investigated in 20 patients with OSAS: 4 female, 16 male; age 53.0 +/- 7.8 years, body mass index (BMI) 28.0 +/- 3.0 kg.m-2; apnoea hypopnoea index (AHI) 35.6 +/- 17.8 h-1. Patients with asthma, chronic obstructive pulmonary disease (COPD), and left heart failure were excluded. Placebo or verum (50 micrograms Salmeterol) were administered at 7 p.m. by metered dose inhaler and spacer device. All patients underwent full polysomnography during baseline, placebo, and verum night. Statistical analysis was performed by Student's t-test (p < 0.05). Between placebo and verum there were no differences in total sleep time, sleep stages, apnoea index (AI), AHI, and nadir SaO2. There was, however, a significant deterioration of mean SaO2 (placebo 93.1 +/- 2.0 vs Salmeterol 92.5 +/- 2.2%) and of relative time spent with SaO2 < or = 90% (placebo 13.1 +/- 14.5 vs Salmeterol 19.5 +/- 20.8%), as well as a significant increase in heart rate (placebo 63.1 +/- 9.2 vs Salmeterol 65.6 +/- 9.3 h-1). Thus, in patients with OSAS Salmeterol had no adverse effect on quality of sleep, AI or AHI. The slight increase in heart rate and the deterioration of oxygen saturation are clinically irrelevant. The latter might be due to ventilation-perfusion-mismatch. This study demonstrates that Salmeterol has no influence on obstructive sleep apnoea and hypopnoea, but on the other hand provides an acceptable safety profile in OSAS. This might be of special importance in patients suffering from both OSAS and obstructive airway disease.

Vanadate-induced contraction of smooth muscle and enhanced protein tyrosine phosphorylation

This study was guided by the hypothesis that protein tyrosine phosphorylation may participate in signal transduction that is associated with contraction of smooth muscle. Accordingly, because sodium vanadate stimulates contraction of smooth muscle and inhibits protein tyrosine phosphatases, we sought to determine if vanadate-induced contraction was linked to enhanced protein tyrosine phosphorylation. Pronounced and time-dependent increases (5- to 20-fold) occurred in tyrosine phosphorylation during vanadate-induced contraction of guinea pig taenia coli. Three substrates of 86, 116, and 205 kDa were tyrosine phosphorylated as detected by immunoblotting with phosphotyrosine monoclonal antibody. Vanadate-induced contraction and enhanced protein tyrosine phosphorylation were both reduced in the presence of 2.5-5 micrograms/ml genistein, a potent tyrosine kinase inhibitor. In the continued presence of vanadate, chelation of extracellular Ca2+ with 5 mM ethylene glycol bis(beta-aminoethyl ether) N,N'-tetraacetic acid (EGTA) caused relaxation. However, pronounced phosphorylation of the substrates persisted even though isometric force decreased to control level. In this setting, replacement of the muscle bathing medium with fresh vanadate and EGTA-free medium caused a prompt spontaneous contraction which was immediately followed by relaxation and dephosphorylation of the substrates. Similarly, blockade of Ca(2+)-entry sites with 10 mM LaCl3 also relaxed smooth muscle strips that had been contracted with 1.5 mM vanadate. However, unlike EGTA-induced relaxation, replacement of the medium with fresh vanadate and LaCl3-free medium did not cause a spontaneous contraction. Taken together, these results show that vanadate-induced contraction of smooth muscle is probably coupled to enhanced protein tyrosine phosphorylation. The results also suggest that tyrosine phosphorylation may participate in Ca(2+)-dependent signalling mechanisms which regulate contraction of smooth muscle.

Multiple personality disorder and borderline personality disorder. Distinct entities or variations on a common theme?

We report data from a comparison of 14 subjects with multiple personality disorder (MPD) and 13 subjects with borderline personality disorder (BPD). There were few significant differences between the groups. The authors discuss the concept of MPD as an epiphenomenon of BPD, and argue their fundamental similarity.

[The beta adrenergic system of lymphocytes in children with atopic dermatitis]

A defect in the beta-adrenergic system is considered to be one of the basal causes of atopic dermatitis (AD). The number and affinity (KD) of beta-receptors was determined in lymphocytes of 19 children with AD and of 17 controls using the radioligand 125JCYP to find out whether this hypothesis is relevant. In addition, the basal cAMP level was measured as well as the cAMP-accumulation after stimulation of the adenylcyclase (AC) via the beta-receptor with 10(-4) M isoprenaline (IPN) and after direct stimulation of AC with 10(-4) M forskolin. Receptor quality and receptor quantity were compared to the severity of AD. A statistically significant difference between AD and control children was not registered for the following parameters: receptor-density, affinity for 125ICYP, cAMP-accumulation after adenylcyclase stimulation via the beta-receptor with IPN or after direct stimulation with forskolin. The increase in cAMP after IPN or forskolin was in the same range for children suffering from AD as for controls. Only the basal cAMP was significantly lower. Three patients with very severe AD (greater than 20% body surface area) had a significantly reduced number of beta-receptors (603 +/- 123 BS/Ly) compared with the control group (1142 +/- 112 BS/Ly). A linear relation existed between age, receptor density and isoprenaline-mediated cAMP accumulation for both control children and those with AD. This age-dependent response of the beta-receptor seems to be specific as cAMP-accumulation after stimulation with forskolin was not age-related.

The chromosomal arrangement of human alpha-like globin genes: sequence homology and alpha-globin gene deletions

We report the isolation of a cluster of four alpha-like globin genes from a bacteriophage lambda library of human DNA (Lawn et al., 1978). Analysis of the cloned DNA confirms the linkage arrangement of the two adult alpha-globin genes (alpha 1 and alpha 2) previously derived from genomic blotting experiments (Orkin, 1978) and identifies two additional closely linked alpha-like genes. The nucleotide sequence of a portion of each of these alpha-like genes was determined. One of these sequences is tentatively identified as an embryonic zeta-globin gene (zeta 1) by comparison with structural data derived from purified zeta-globin protein (J. Clegg, personal communication), while the other sequence cannot be matched with any known alpha-like polypeptide sequence (we designate this sequence phi alpha 1). Localization of the four alpha-like sequences on a restriction map of the gene cluster indicates that the genes have the same transcriptional orientation and are arranged in the order 5'-zeta 1-phi alpha 1-alpha 2-alpha 1-3'. Genomic blotting experiments identified a second, nonallelic zeta-like globin gene (phi 2) located 10-12 kb 5' to the cloned zeta-globin gene. Comparison of the locations of restriction sites within alpha 1 and alpha 2 and heteroduplex studies reveal extensive sequence homology within and flanking the two genes. The homologous sequences, which are interrupted by two blocks of nonhomology, span a region of approximately 4 kb. This extensive sequence homology between two genes which are thought to be the products of an ancient duplication event suggests the existence of a mechanism for sequence matching during evolution. One consequence of this arrangement of homologous sequences is the occurrence of two types of deletions in recombinant phage DNA during propagation in E. coli. The locations and sizes of the two types of deletions are indistinguishable from those of the two types of deletions associated with alpha-thalassemia 2 (Embury et al., 1979; Orkin et al., 1979; S. Embury et al., manuscript submitted). This information strongly suggests that the genetic disease is a consequence of unequal crossing over between homologous sequences within and/or surrounding the two adult alpha-globin genes.

The isolation of structural genes from libraries of eucaryotic DNA

We present a procedure for eucaryotic structural gene isolation which involves the construction and screening of cloned libraries of genomic DNA. Large random DNA fragments are joined to phage lambda vectors by using synthetic DNA linkers. The recombinant molecules are packaged into viable phage particles in vitro and amplified to establish a permanent library. We isolated structural genes together with their associated sequences from three libraries constructed from Drosophila, silkmoth and rabbit genomic DNA. In particular, we obtained a large number of phage recombinants bearing the chorion gene sequence from the silkmoth library and several independent clones of beta-globin genes from the rabbit library. Restriction mapping and hybridization studies reveal the presence of closely linked beta-globin genes.

The bacteriological quality of hemodialysis solution as related to several environmental factors

The bacterial concentrations of the municipal water increased by more than 39-fold when subjected to reverse osmosis; then decreased by greater than 200-fold within the reservoir and water supply system of the hemodialysis center. The bacterial concentrations of dialysate solutions in contact with proportioning single-pass artificial kidney machines were as low or lower than the water from the hemodialysis center system (less than 10 CFU/100 ml.). The complete opposite was observed in the recirculating single-pass artificial kidney machines where bacterial concentrations in the dialysate solution reached levels greater than 1.0 X 10(6) CFU/100 ml.